Managing Poor Weight Gain in Your Breastfed Infant
Sometimes, a breastfed baby will gain weight more slowly than he or she should. This
could be because the mother isn't making enough milk, the baby can't get enough milk
out of the breast, or the baby has a medical problem. Your baby's healthcare provider
should evaluate any instance of poor weight gain. Often, a certified lactation consultant
can help. Below are some general tips for addressing poor weight gain in a breastfed
Check the schedule
Watch for signs from your baby that he or she wants to feed. Your baby should wake
and "cue" to breastfeed about 8 to 12 times in 24 hours by rooting, making licking
or sucking motions, bobbing his or her head or bringing his or her hand to the face
or mouth. It is important for you to recognize these feeding cues and put your baby
to your breast when he or she cues. Don't wait for your baby to cry. Crying is a late
feeding cue. Usually a baby latches and breastfeeds better if he or she does not have
to wait until he or she is crying, frustrated, or too tired to feed. Putting a baby
off to try to get the baby to go longer between feedings and frequently offering a
pacifier instead of the breast when a baby demonstrates feeding cues are often linked
to poor weight gain.
Many mothers find milk production increases and babies' weight gains improve if they
and their babies let chores and activities go for 2 or 3 days, so they can breastfeed,
more or less, around the clock. When a baby is not breastfeeding, the mother holds
him or her skin-to-skin on her chest, which often helps her become more sensitive
to the baby's feeding cues.
If your baby is a "sleepy" baby who does not cue to feed at least 8 times in 24 hours,
you will have to wake the baby to feed frequently--about every 2 hours during the
daytime and evening hours and at least every 3 to 4 hours at night until weight gain
It can help to write down when your baby nurses, on which side, and for how long for
a full 24 hours, if not longer. Take this record to your healthcare provider or lactation
consultant to help find and fix the problem.
Latching and positioning
Be sure your baby is mainly uncovered during breastfeeding. A baby that is bundled
papoose-style may get much too warm and comfy, and he or she is more likely to doze
off too quickly during feedings. If there is a chill in the air, drape a sheet or
light blanket over you and the baby, as needed.
If your baby falls asleep within minutes of latching on, massage your breast as he
or she nurses. This can provide a burst of milk and re-trigger sucking. You can do
this by stroking downward and inward on the breast.
Make sure your baby is latching on correctly. The latch should be comfortable to you.
Your baby's lips should be flanged outward like "fish lips." The tongue should be
under your breast. A large amount of your breast tissue should be in the baby's mouth.
In general, avoid "switch nursing." That is, breastfeeding at one breast for a few
minutes, then the other, and then back again. This may interfere with your baby getting
enough of the calorie-rich hindmilk, which your baby gets more of as a feeding continues
on one breast. However, the "switch" strategy sometimes stimulates the "sleepy" baby
so he or she wakes up and starts sucking again.
If your healthcare provider recommends supplementing
Use your own expressed milk first for any alternative feedings.
Use an alternative feeding method if it is recommended by your healthcare provider
or a certified lactation consultant (IBCLC). There are many alternative feeding options,
so let them know if a recommendation does not "feel right" for you. Alternative feeding
Several methods require assistance from a professional, such as a certified lactation
consultant (IBCLC) so you can use them correctly. Depending on your baby and the cause
of the problem, some methods may work better than others. Also, discuss bottle nipple
type with the IBCLC if you bottle-feed any supplement. Some types of bottle nipples
are less likely to interfere with breastfeeding than others.
Maintaining or increasing your milk supply
Pump your breasts after as many daily breastfeedings as possible, especially if you
are uncertain whether your baby is effectively removing milk during breastfeeding.
Many women find that trying for 8 times per day is manageable and helpful for their
Pumping will remove milk effectively, so your breasts will know to make more milk.
Pumping will also express supplemental milk for feeds. Milk can be removed from the
breast by manual hand expression, a hand pump, a battery-powered pump, or an electric
breast pump. If frequent and prolonged pumping is anticipated, a hospital-grade, electric
pump can be very helpful.
Checking baby's weight
Your baby should be weighed on a frequent and regular basis until he or she is gaining
weight at a satisfactory rate. Digital scales are available that allow a healthcare
provider or a certified lactation consultant (IBCLC) to get precise pre- and post-feeding
weights to measure how much milk a baby takes in during a particular breastfeeding.
Although this can be helpful, babies take in different amounts at different feedings
throughout a 24-hour period. Therefore, a professional may recommend that parents
rent this type of scale so a baby can be weighed before and after different feedings.
They also may suggest recording only a daily or weekly weight, depending on the situation.
Call your baby's healthcare provider
If your baby ever shows signs of dehydration, call your baby's healthcare provider
right away. Some signs of dehydration in a baby include:
Fewer stools and wet diapers than usual
Sunken fontanelle (soft spot)
Dark circles around the eyes
Appearing more tired than usual
If breastfeeding is properly managed, yet the baby still is not gaining enough weight,
it is likely that some other factor is affecting milk production or the baby's ability
to breastfeed effectively. Always consult your own, and your baby's healthcare provider.